体外膈肌起搏治疗联合有氧呼吸操对卒中偏瘫患者肺功能的疗效

doi:10.16138/j.1673-6087.2022.03.013

摘要/Abstract

摘要：

目的：探讨体外膈肌起搏联合有氧呼吸操对卒中偏瘫患者膈肌功能的影响以及肺康复的疗效。方法：选取上海市第四康复医院2019年5月至2020年4月首诊为卒中偏瘫患者65例,年龄（73.90+3.81）岁。根据是否采用膈肌起搏治疗,分为有氧呼吸操治疗组（对照组）（n=31）和有氧呼吸操+膈肌起搏治疗组（干预组）（n=34）。所有患者均完成治疗共12周。治疗前后均进行肺功能、膈肌超声测定。比较治疗前后及组间各参数的差异。结果：经治疗后,干预组肺功能参数、膈肌厚度[（0.22±0.01） cm比（0.20±0.02） cm]、膈肌平静活动度[（1.44±0.13） cm比（1.31±0.96） cm]、膈肌最大活动度[（3.98±0.49） cm比（3.23±0.35） cm]均显著提高（均P<0.001）;对照组治疗后第1秒用力呼气容积（forced expiratory volume in one second, FEV₁）和FEV₁/用力肺活量（forced vital capacity, FVC）以及膈肌活动度有显著改善（均P<0.005）,而FVC及膈肌厚度差异无统计学意义。干预组在肺功能参数和膈肌功能评价上均明显优于对照组（均P<0.05）。结论：体外膈肌起搏联合有氧呼吸操治疗对卒中偏瘫患者的膈肌活动度以及肺功能有明显改善作用。

关键词: 卒中, 偏瘫, 肺功能, 膈肌, 体外膈肌起搏

Abstract:

Objective: To investigate the effect of extracorporeal diaphragmatic pacing combined with aerobic breathing exercise on diaphragmatic function and pulmonary rehabilitation in the stroke patients with hemiplegia. Methods The study was conducted in 65 patients [age (73.90±3.81) years] with hemiplegia after stroke in the Fourth Rehabilitation Hospital of Shanghai from May 2019 to April 2020. According to using diaphragmatic pacing or not, the patients were divided into aerobic breathing exercise group (control group, n=31) and aerobic breathing exercise + diaphragmatic pacing treatment group (intervention group, n=34). Before and after a 12-week-treatment, the pulmonary function and diaphragmatic ultrasound were used to evaluate all patients, and the difference of parameters before and after treatment in the group and between groups was compared. Results After treatment, the indexes including pulmonary function parameters, diaphragm thickness [(0.22±0.01) cm vs. (0.20±0.02) cm], diaphragmatic calm activity [(1.44±0.13) cm vs. (1.31±0.96) cm], maximum diaphragmatic activity [(3.98±0.49) cm vs. (3.23±0.35) cm] were all significantly improved in the aerobic breathing exercise + diaphragm pacing group (all P<0.001). The forced expiratory volume in one second (FEV₁), FEV₁/forced vital capacity (FVC) and diaphragmatic activity in the control group were significantly improved (all P<0.005), while the FVC and diaphragm thickness didn’t show statistical difference(P>0.05). The pulmonary function parameters and diaphragmatic function evaluation in the intervention group were significantly ameliorated than those in the control group (all P<0.05). Conclusions The external diaphragmatic pacing combined with aerobic breathing exercise can significantly improve the diaphragmatic activity and lung function in the stroke patients with hemiplegia.

Key words: Stroke, Hemiplegia, Lung function, Diaphragm, External diaphragm pacing

中图分类号:

R743

许轶明, 沈宏华, 张音, 任蕾. 体外膈肌起搏治疗联合有氧呼吸操对卒中偏瘫患者肺功能的疗效[J]. 内科理论与实践, 2022, 17(03): 243-247.

XU Yiming, SHEN Honghua, ZHANG Yin, REN Lei. Effect of extracorporeal diaphragmatic pacing combined with aerobic breathing exercise on pulmonary function in stroke patients with hemiplegia[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(03): 243-247.

图/表 2

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项目	对照组（n=34）	干预组（n=31）	χ²/t	P
年龄（岁）	72.74±4.41	72.52±4.68	0.195	0.846
男性/女性	16/18	15/16	0.011	0.915
BMI（kg/m²）	22.43±1.75	22.52±1.95	-0.188	0.851
发病时间（d）	72.91±20.94	71.22±19.46		0.739
患侧肌力1-2-3-4级（n）	4-16-11-3	4-14-9-4	0.338	0.953
NIHSS评分（分）	12.26±2.34	12.4±2.29	0.335	0.746
吸烟（是/否）	15/19	14/17	0.007	0.933
基础疾病[n（%）]
高血压	29（85.3）	24（77.4）	0.668	0.414
冠心病	19（55.9）	19（61.3）	0.195	0.659
糖尿病	8（23.5）	8（25.8）	0.045	0.831
慢性阻塞性肺疾病	11（32.4）	9（29）	0.084	0.772

项目	对照组（n=34）	干预组（n=31）	χ²/t	P
FEV₁（L）
治疗前	2.07±0.33	2.10±0.37	-0.420	0.676
治疗后	2.07±0.33	2.24±0.35	0.603	0.048
P	<0.001	<0.001
FVC（L）
治疗前	2.40±0.42	2.45±0.44	-0.493	0.624
治疗后	2.42±0.40	2.69±0.43	0.405	0.009
P	0.280	<0.001
FEV₁/FVC（%）
治疗前	86.48±3.68	85.96±3.48	0.579	0.565
治疗后	85.75±3.54	83.23±2.42	3.386	0.001
P	0.003	0.002
膈肌厚度（cm）
治疗前	0.20±0.02	0.19±0.02	0.820	0.415
治疗后	0.20±0.02	0.22±0.01	-7.083	<0.001
P	0.160	<0.001
平静呼吸膈肌活动度（cm）
治疗前	1.28±0.10	1.24±0.10	1.702	0.094
治疗后	1.31±0.93	1.45±0.13	-4.921	<0.001
P	<0.001	<0.001
深呼吸膈肌活动度（cm）
治疗前	3.06±0.35	2.91±0.33	1.818	0.074
治疗后	3.24±0.34	3.96±0.49	-6.818	<0.001
P	<0.001	<0.001